Endocrine

A nurse is providing education for a patient with a new diagnosis of type I diabetes mellitus. Therapy for the patient will require subcutaneous insulin injections several times per day. When teaching the patient how to administer subcutaneous insulin, what education is the most accurate? "You must use an alcohol swab on the site before self-injection." "If you are planning on going jogging, you should use the thigh injection site to administer insulin." "You should use one site for insulin injections so you get used to the process of administering insulin." "Avoid injecting insulin intramuscularly, because rapid and unpredictable absorption could result in hypoglycemia."

"Avoid injecting insulin intramuscularly, because rapid and unpredictable absorption could result in hypoglycemia." Patient education for administration of insulin for diabetes should include teaching the patient to avoid intramuscular injections because of the rapid and unpredictable absorption that could result in hypoglycemia. The use of an alcohol swab on the site before self-injection is no longer recommended. Routine hygiene such as washing with soap and water is adequate. Patients should be taught to avoid injection sites that will be exercised, because doing so could increase body heat and circulation, increase the rate of insulin absorption, and speeding up the onset of action, resulting in hypoglycemia. Patients should be taught to rotate the injection within and between sites, not to use one site, to allow for better insulin absorption. p. 1127

The registered nurse is teaching a student nurse about assessing a patient with Cushing syndrome who is on corticosteroid therapy. Which statement made by the student nurse about assessment would need correction? "I will assess the risk for infection." "I will assess for postural changes." "I will assess for imbalanced nutrition." "I will assess for disturbed body image."

"I will assess for postural changes." Postural changes should be assessed for patients with orthostatic hypotension. A patient on corticosteroid therapy does not need postural changes checked because corticosteroids do not have an effect on orthostatic hypotension. The patient should be assessed for infection because corticosteroids cause immunosuppression. The patient may have increased appetite and may show inactivity; thus, nutrition should be balanced. Body image should be assessed because the disease may cause a change in appearance. p. 1176

Which statement by a patient shows ineffective learning about diabetes management? "I will exercise daily." "I will drink fruit juices daily." "I will walk wearing shoes daily." "I will have yearly influenza vaccination."

"I will drink fruit juices daily." Having fruit juices daily does not help in diabetes management, because it contains sugars that are easily absorbed. Exercising daily helps to maintain good health. Wearing shoes daily will avoid injuries to feet, which is important, because wound healing is delayed in diabetic patients. Diabetic patients have weakened immune systems and are more prone to flu. Therefore, annual vaccination against influenza is required. p. 1142

The nurse is evaluating the outcome of patient teaching regarding aspart insulin. The patient demonstrates an appropriate understanding when stating: "This insulin is used to treat the elevated sugar that occurs after meal intake." "I cannot mix this insulin in the same syringe with any other type of insulin." "I need to plan my meals well so I can inject my insulin 30 minutes before I begin to eat." "The best thing about this type of insulin is I take it at bedtime and it works for 24 hours."

"This insulin is used to treat the elevated sugar that occurs after meal intake." Rapid-acting insulins, such as aspart, are used to control postprandial blood glucose levels. The timing of insulin injection with meals is crucial. Rapid-acting insulin has a quick onset of approximately 15 minutes and should be injected within 15 minutes of mealtime. Short-acting insulin, such as Humulin-R, because of longer onset of action, can safely be administered 30 to 60 minutes before a meal. Rapid-acting insulin such as aspart can be mixed safely with intermediate-acting insulin in the same syringe. Long-acting insulin such as glargine and detemir should not be mixed with any other insulins. Because rapid acting insulins have a shorter duration of action, they are typically injected before meals. p. 1125

A patient is prescribed lispro therapy. Related to meal times, the nurse should instruct the patient to administer the insulin when? -On an empty stomach, between meals -Simultaneously with a meal -15 minutes after a meal -30 to 45 minutes before a meal

-15 minutes after a meal Lispro is a rapid-acting synthetic insulin that has an onset of action of approximately 15 minutes. Lispro should be administered 15 minutes after mealtime because its rapid action closely mimics natural insulin secretion in response to a meal. Lispro is not administered on an empty stomach or simultaneously with a meal. Short-acting regular insulin, not rapid-acting synthetic insulin, is administered 30 to 45 minutes before a meal to ensure the onset of action coincides with meal absorption. pp. 1125-1126

A patient whose laboratory report shows a blood glucose level of 290 mg/dL, serum bicarbonate of 13 mEq/L, serum potassium of 3 mEq/L, and arterial blood pH of 6 is on therapeutic management. At a follow-up visit, the patient has severe hypokalemia (2 mEq/L). Which therapeutic intervention might have caused severe hypokalemia in this patient? -Administration of 0.9 percent NaCl -Administration of 1 mg glucagon -Administration of 5 percent to 10 percent dextrose -Administration of 0.1 U/kg/hr of insulin

-Administration of 0.1 U/kg/hr of insulin Blood glucose of 290 mg/dL, serum bicarbonate of 13 mEq/L, serum potassium of 3 mEq/L, and arterial blood pH of 6 indicates that the patient has diabetic ketoacidosis. Administration of 0.1 U/kg/hr of insulin is responsible for the severe hypokalemia. Administration of 0.9 percent NaCl is useful for fluid restoration in patients with dehydration. Administration of 1 mg glucagon is beneficial for patients with severe hypoglycemia; 5 percent to 10 percent dextrose is added to the fluid regimen of diabetic ketoacidosis patients when blood sugar level approaches 250 mg/dL. p. 1144

The nurse is caring for a patient being treated for acute thyrotoxicosis. What are the nursing interventions for this patient exhibiting exophthalmos? Apply artificial tears. Tape the eyelids lightly for sleeping, if needed. Ask the patient to exercise the intraocular muscles. Place the patient in a supine position. Avoid elevating the patient's head.

-Apply artificial tears. -Tape the eyelids lightly for sleeping, if needed. -Ask the patient to exercise the intraocular muscles. Nursing interventions for the patient exhibiting exophthalmos include application of artificial tears to soothe and moisten conjunctival membranes, to relieve eye discomfort, and to prevent corneal ulceration. If the eyelids cannot be closed, the nurse should lightly tape them shut to help the patient sleep. To maintain flexibility, the patient must be taught to exercise the intraocular muscles several times a day by turning the eyes in the complete range of motion. The patient should sit upright as much as possible. The head must be elevated to promote fluid drainage from the periorbital area. p. 1167

Which nursing interventions are appropriate when providing care to a patient that is recovering from a thyroidectomy? Assessing for tetany Monitoring vital signs Monitoring potassium levels Assessing the patient every two hours on the first postoperative day Placing the patient in a high Fowler's position

-Assessing for tetany -Monitoring vital signs -Assessing the patient every two hours on the first postoperative day Postoperative nursing interventions that are appropriate for a patient after a thyroidectomy include assessing for tetany, monitoring vital signs, and assessing the patient every two hours on the first postoperative day for hemorrhage and tracheal compression. The nurse should monitor calcium levels, not potassium levels. The nurse should place the patient in a semi-Fowler's position to reduce swelling and edema in the neck area. Sandbags or pillows may be used to support the head or neck. pp. 1167-1168

The nurse is preparing the care plan for a patient with diabetes who is on bromocriptine therapy. Which intervention included in the care plan will be beneficial for the patient? Providing vitamin K-rich food Monitoring serum thyroid levels Assisting the patient when changing position Monitoring for the symptoms of myocardial infarction

-Assisting the pt when changing positions Bromocriptine is a dopamine agonist that may cause orthostatic hypotension, which in turn causes the patient to become dizzy when changing position. Therefore, the nurse should assist the patient when changing position to prevent accidental falls. Bromocriptine does not reduce absorption of vitamin K. Hence, the nurse does not provide vitamin K-rich food to the patient. The nurse does not monitor thyroid hormone levels, because bromocriptine does not impair thyroid functioning. Bromocriptine does not increase the risk of myocardial infarction. pp. 1131, 1132

The nurse is caring for a patient with pheochromocytoma. Which intervention would help prevent the sudden release of catecholamines and sudden hypertension? -Nourishing the patient with a healthy diet -Avoiding palpations of the patient's abdomen -Advising the patient to rise slowly from the bed -Administering α- and β-blockers preoperatively to the patient

-Avoiding palpations of the patient's abdomen The nurse should avoid palpating the abdomen of a patient with suspected pheochromocytoma because the action may cause the sudden release of the catecholamines and severe hypertension. A healthy diet promotes the overall health of the patient. Advising the patient to rise slowly from the bed helps prevent orthostatic hypotension. Administering α- and β-blockers preoperatively helps prevent an intraoperative hypertensive crisis. p. 1181

The nurse is teaching an insulin-dependent diabetic patient about the effects of exercise on blood glucose level. The American Diabetic Association (ADA) recommends moderate activity that expends 200-350 kcal/hr. When collaborating with the patient to develop a self-management plan, what examples of moderate activity does the nurse offer? . Fishing Bowling Dancing Walking briskly Aerobic exercises

-Bowling -Dancing -Walking briskly Examples of moderate activity include bowling, walking briskly, and dancing. The ADA recommends at least 150 minutes per week of moderate activity. Fishing is considered a light activity in which approximately 100-200 kcal/hr are expended. Aerobic exercises are considered vigorous activity expending approximately 400-900 kcal/hr. p. 1134

A patient with type 2 diabetes has a urinary tract infection (UTI). The unlicensed assistive personnel (UAP) reported to the nurse that the patient's blood glucose is 642 mg/dL and the patient is hard to arouse. When the nurse assesses the urine, there are no ketones present. What collaborative care should the nurse expect for this patient? Routine insulin therapy and exercise Administer a different antibiotic for the UTI Cardiac monitoring to detect potassium changes Administer intravenous (IV) fluids rapidly to correct dehydration

-Cardiac monitoring to detect potassium changes This patient has manifestations of hyperosmolar hyperglycemic syndrome (HHS). Cardiac monitoring will be needed because of the changes in the potassium level related to fluid and insulin therapy and the osmotic diuresis from the elevated serum glucose level. Routine insulin would not be enough and exercise could be dangerous for this patient. Extra insulin will be needed. The type of antibiotic will not affect HHS. There will be a large amount of IV fluid administered, but it will be given slowly because this patient is older and may have cardiac or renal compromise, requiring hemodynamic monitoring to avoid fluid overload during fluid replacement. pp. 1145-1146

A nurse is caring for a 62-year-old man with a history of hypertension and type 2 diabetes who has been admitted to the inpatient unit for pneumonia. The nurse enters the patient's room to complete an admission assessment and notices that the patient has slurred speech and right-sided weakness. After calling the rapid response team, what is the nurse's next action? Obtain vital signs. Obtain a crash cart. Check blood glucose. Perform a neurologic assessment.

-Check blood glucose. The patient's blood glucose levels in hyperosmolar hyperglycemic syndrome are high; they increase serum osmolality and produce severe neurologic manifestations, such as aphasia and hemiparesis. It is critical to check the patient's blood glucose level for correct diagnosis and treatment, because these signs and symptoms resemble those of a stroke. Obtaining vital signs is not the next action to take; that can happen later. Obtaining the crash cart is not necessary in this situation. Performing a neurologic assessment can be done, but it is not the next action the nurse should take. p. 1145

A nurse is caring for a patient who underwent subtotal thyroidectomy because of the overproduction and release of thyroid hormone. Postoperative nursing interventions are important to prevent complications after surgery. Which nursing interventions should the nurse implement for safe, effective care? Monitor vital signs and potassium levels. Control postoperative pain by administering medication. Place the patient supine and support the head with pillows. Assess for signs of tetany secondary to hypoparathyroidism. Assess the patient every two hours for signs of bleeding or tracheal compression.

-Control postoperative pain by administering medication. -Assess for signs of tetany secondary to hypoparathyroidism. -Assess the patient every two hours for signs of bleeding or tracheal compression. Nursing interventions after a thyroidectomy are important to prevent complications, such as airway obstruction. These interventions include controlling pain with medication; assessing for signs of tetany (i.e., tingling in toes, fingers, and around the mouth, Trousseau sign, and Chvostek sign); and assessing the patient every two hours for signs of bleeding and tracheal compression. Monitoring vital signs is important, but monitoring potassium levels is not; the calcium levels should be monitored. The patient should be placed in a semi-Fowler's position, not supine, with the head supported with pillows. p. 1168

The nurse is conducting a teaching session about nephropathy as a complication of diabetes. Which information would be appropriate for the nurse to include in the session? Vessels may begin to bleed, resulting in permanent blindness. Controlling blood sugar and blood pressure will reduce the risk of kidney injury. Organ damage resulting from changes in large and medium-sized blood vessels can be prevented by careful glucose control. This will not occur if one does not require insulin to control diabetes.

-Controlling blood sugar and blood pressure will reduce the risk of kidney injury. Microangiopathy occurs in diabetes mellitus. When the kidneys are affected, the patient has nephropathy. Maintaining control of blood sugar and blood pressure will decrease microvascular organ damage and help to preserve kidney function. Blindness occurs as a result of microvascular damage, not bleeding. Organ damage is caused from small vessel damage. Regardless of the treatment type, nephropathy can occur if blood sugars are not controlled properly. pp. 1148-1149

A patient with type 2 diabetes mellitus (DM) is prescribed an oral hyperglycemic agent. The nurse provides the patient with a list of food items with a high glycemic index (GI). What should the nurse include on the list? Baked beans, parboiled rice, and regular milk Oatmeal with regular milk, sweet corn, and a cup of green pea soup Apple, oat bran cereal with regular milk, and slices of raw sweet potatoes Cornflake cereal with regular milk and white bread sandwich with potato stuffing

-Cornflake cereal with regular milk and white bread sandwich with potato stuffing Glycemic index (GI) is the term used to describe the rise in blood glucose levels after a person consumes a food containing carbohydrates. Foods with high GI raise glucose levels higher and more quickly than foods with a low GI. Cornflake cereal, white bread, and potatoes have a GI above 70. Baked beans, parboiled rice, oatmeal, sweet corn, and green pea soup have a medium GI ranging from 56 to 69. Apples, oat bran cereal, regular milk, and raw sweet potatoes have a low GI of about 55 or less. pp. 1132-1134

The newly diagnosed patient with type 2 diabetes has been prescribed metformin. What should the nurse tell the patient to best explain how this medication works? Increases insulin production from the pancreas Slows the absorption of carbohydrate in the small intestine Decreases rate of hepatic glucose production; augments glucose uptake by tissues, especially muscles Increases insulin release from the pancreas, inhibits glucagon secretion, and decreases gastric emptying

-Decreases rate of hepatic glucose production; augments glucose uptake by tissues, especially muscles Metformin is a biguanide that decreases the rate of hepatic glucose production and augments glucose uptake by tissues, especially muscles. Sulfonylureas and meglitinides increase insulin production from the pancreas. α-glucosidase inhibitors slow the absorption of carbohydrate in the intestine. Glucagon-like peptide receptor agonists increase insulin synthesis and release from the pancreas, inhibit glucagon secretion, and decrease gastric emptying. p. 1130

The nurse is caring for a patient who received treatment for hypoparathyroidism and later developed hypocalcemia. Which is the goal of the treatment regimen for this condition? -Increasing the pH -Decreasing the pH -Maintaining the pH -Decreasing the calcium ionization level

-Decreasing pH A decreased pH will cause an acidic environment and increase the calcium ionization, which will in turn increase the available calcium in the blood and help the patient to recover from hypocalcemia. An increased pH will decrease calcium ionization, thereby decreasing the calcium level in the blood. If the pH is maintained, then there will be a nullifying effect on the calcium level. If the calcium ionization level is decreased, then the available calcium in the blood will become low. pp. 1173-1174

Which complication can be monitored by annual screening using a monofilament? Diabetic neuropathy Diabetic retinopathy Diabetic dermopathy Diabetic nephropathy

-Diabetic neuropathy Sensory neuropathy is a type of diabetic neuropathy in which loss of protective sensation (LOPS) is common. LOPS may lead to lower extremity amputation. Therefore, annual screening using a monofilament is important in monitoring the patient for diabetic neuropathy. Diabetic retinopathy is monitored by annual fundoscopic examination. Examining the skin changes is important in diabetic patients to monitor for diabetic dermopathy. Serum creatinine and urinalysis for microalbuminuria help to monitor for diabetic nephropathy. pp. 1150-1151

Which clinical manifestations does the nurse expect during the assessment of a hospitalized patient experiencing exophthalmos? Dyspnea Celiac disease Cardiac hypertrophy Distended abdomen Bounding, rapid pulse

-Dyspnea -Cardiac hypertrophy -Bounding, rapid pulse Exophthalmos is a classic finding in Graves' disease, which is caused by hyperthyroidism. Clinical manifestations anticipated by the nurse upon assessment include a bounding, rapid pulse; cardiac hypertrophy; and dyspnea. Clinical symptoms such as celiac disease and distended abdomen are associated with hypothyroidism. p. 1164

Which clinical manifestations does the nurse expect in a hospitalized patient diagnosed with Graves' disease? -Anemia -Dysrhythmia -Systolic murmurs -Distant heart sounds -Systolic hypertension

-Dysrhythmia -Systolic murmurs -Systolic hypertension Graves' disease is a term used to describe hyperthyroidism. Clinical manifestations associated with this disease process include tachycardia, dysrhythmia, systolic murmurs, and systolic hypertension. Hypothyroidism is associated with anemia and distant heart sounds. pp. 1163-1164

A patient diagnosed with hyperthyroidism presents with neck nodules that are less than 3 cm in size. Biopsy reveals the nodules are non-malignant. Which treatment does the nurse expect for this patient? Iodine therapy Subtotal thyroidectomy Endoscopic thyroidectomy Radioactive iodine therapy

-Endoscopic thyroidectomy Endoscopic thyroidectomy is a surgical procedure performed on a patient's neck nodules that are less than 3 cm in size and non-malignant. Iodine is used with other antithyroid drugs in preparation for a thyroidectomy. Iodine therapy/radioactive iodine therapy treats hyperthyroidism by gradually shrinking the thyroid. Radioactive iodine therapy has a delayed effect on the thyroid gland, and it limits the thyroid hormone secretion by damaging thyroid tissue. A subtotal thyroidectomy is a surgical procedure that involves removal of 90 percent of the thyroid gland. p. 1166

After admitting a patient with diabetic ketoacidosis (DKA) to the emergency department, which nursing intervention is a priority ? Administer insulin Administer oxygen Insert a Foley catheter Establish an intravenous (IV) access

-Establish an intravenous (IV) access A person with DKA is severely dehydrated, which can be life-threatening. An IV access must be established first to administer fluids. Insulin is administered intravenously only after a potassium level is determined, because insulin administration may cause hypokalemia. Oxygen and a Foley catheter are not normally necessary in treating DKA. pp. 1142-1144

A nurse caring for a patient with type 1 diabetes encourages the patient to exercise regularly as part of diabetes management. What precautions should the patient take when exercising? Exercise after meals. Have a warm-up and cool-down period. Avoid carbohydrate snacks during exercise. Carry glucose tablets or hard candies when exercising. Avoid exercise if blood glucose is equal to 120 mg/dL.

-Exercise after meals. -Have a warm-up and cool-down period. -Carry glucose tablets/hard candies when exercising The nurse should inform the patient to exercise one hour after meals when blood sugar levels are rising. The exercise program should be started gradually and increased slowly, with a warm-up and cool-down period. Patients using medications are at a risk for hypoglycemia when exercising and should always carry a fast-acting source of carbohydrate such as glucose tablets or hard candies or eat small carbohydrate snacks every 30 minutes when exercising. If blood glucose is less than or equal to 100 mg/dL, the patient should retest blood glucose levels after a 15-g carbohydrate snack. The patient should then exercise if glucose levels increase after 15 to 30 minutes. pp. 1134-1135

A patient with diabetes experiences hypoglycemia. What does the nurse educate the patient that a cause of this condition may be? Mild illness with fever Insufficient injection of insulin Overeating at a family holiday dinner Exercise without a carbohydrate-based snack

-Exercise without a carbohydrate-based snack Exercise without a carbohydrate-based snack could result in hypoglycemia. Mild illness, insufficient insulin dosage, and overeating are situations that would cause hyperglycemia, or an increased blood glucose level. p. 1134

After giving 6 oz. of orange juice to a patient with hypoglycemia, the nurse finds that the patient's blood glucose level is 65 mg/dL. What would be the most appropriate nursing action in this situation? Giving 15 g of carbohydrate Administering 5 percent to 10 percent dextrose infusion Giving 25 to 50 mL of 50 percent glucose intravenously Administering 1 mg intramuscular (IM) glucagon

-Giving 15 g of carbohydrate A patient with a blood glucose level less than 70 mg/dL should be given 15 g of carbohydrates (5 to 6 oz. of fruit juice) initially. If the glucose is still less than 70 mg/dL, then another 15 g of carbohydrates should be given. Dextrose (5 percent to 10 percent) is added to the fluid regimen in patients who are on treatment for diabetic ketoacidosis if the blood glucose level approaches 250 mg/dL. Administering 25 to 50 mL of 50% glucose intravenously and 1 mg IM glucagon is indicated for an unconscious patient or if the symptoms of hypoglycemia are worsening. pp. 1133-1134, 1146

The nurse has been teaching a patient newly diagnosed with diabetes mellitus to test his or her own blood glucose level. During evaluation of his or her technique, the nurse determines that the teaching has been adequate when the patient performs which task? -Reports control of diabetes is present when blood sugar level is less than 65 mg/dL -Chooses a puncture site in the center of the finger pad -Runs the hand under cool water for 30 seconds to cleanse the site -Hangs the arm in the dependent position for one minute before puncturing

-Hangs the arm in the dependent position for one minute before puncturing Hanging the hand down will promote blood flow to the finger and allow for an adequate blood sample. A blood sugar of 65 mg/dL is considered low and does not necessarily mean the diabetes is well controlled. The patient should select a site on the side of a fingertip, not on the center of a finger pad, and the site should be washed with soap and warm water. p. 1136

The nurse is caring for a patient who underwent removal of the thyroid gland (thyroidectomy) three days ago. The patient's serum chemistries reveal calcium of 3.2 mg/dL, potassium of 3.9 mEq/L, and phosphorus of 4.0 mg/dL. What condition do these findings indicate? Hypocalcemia Hypercalcemia Hyperkalemia Hypophosphatemia

-Hypocalcemia Hypocalcemia is a low serum calcium level. Surgical removal of the thyroid gland may also include removal of the parathyroid gland. This results in a deficiency of parathyroid hormone, which controls serum calcium by regulating absorption of calcium from the gastrointestinal tract, mobilizing calcium in bones, and excreting calcium in breast milk, feces, sweat, and urine. The normal serum calcium level ranges from 9.0 to 11.5 mg/dL. Potassium is within normal limits (3.5 to 5 mEq/L), and phosphorus is also within normal limits (2.8 to 4.5 mg/dL). pp. 1167, 1168

Which is a clinical manifestation of Cushing syndrome? Hypovolemia Hypokalemia Hyperkalemia Hyponatremia

-Hypokalemia Hypokalemia is a sign of Cushing syndrome because of the hyperfunctioning of the adrenal cortex. Hypovolemia, hyperkalemia, and hyponatremia are clinical manifestations of Addison's disease because of the hypofunctioning of the adrenal cortex. p. 1174

Which symptoms may be observed in patients with diabetic ketoacidosis? Hypovolemia Volume overload Visual disturbances Soft and sunken eyes Sweet fruity odor of breath

-Hypovolemia -Soft and sunken eyes -Sweet fruity odor of breath Dehydration in patients with diabetic ketoacidosis results in hypovolemia, soft and sunken eyes, and sweet fruity odor of breath. Volume overload is common in diabetic patients with cardiac or renal compromise. Visual disturbances may result from severe hypoglycemia. pp. 1142-1144

Laboratory results have been obtained for a patient with a 15-year history of type 2 diabetes. Which result reflects the expected pattern accompanying macrovascular disease as a complication of diabetes? Increased triglyceride levels Increased high-density lipoproteins (HDL) Decreased low-density lipoproteins (LDL) Decreased very-low-density lipoproteins (VLDL)

-Increased triglyceride levels Macrovascular complications of diabetes include changes to large- and medium-sized blood vessels. They include cerebrovascular, cardiovascular, and peripheral vascular disease. Increased triglyceride levels are associated with these macrovascular changes. Increased HDL, decreased LDL, and decreased VLDL are positive in relation to atherosclerosis development. p. 1148

A patient is scheduled for a total thyroidectomy. What information does the nurse include when teaching this patient about recovery after the procedure? Exercise will be restricted for up to six months. A low- or no-sodium diet will be prescribed. Physical therapy will need to be continued. Life-long hormone replacement will be needed.

-Life-long hormone replacement will be needed. This patient will need life-long thyroid hormone replacement with levothyroxine because the entire thyroid gland will be missing after surgery. Exercise will not be restricted for six months. Lengthy exercise restriction or physical therapy generally is not indicated following a thyroidectomy. A sodium-restricted diet would not ordinarily be necessary. pp. 1167-1168

The nurse is instructing a diabetic patient who has infrequent voiding, difficulty voiding, and a weak stream of urine. Which action indicates the need for additional teaching? Emptying the bladder for every three hours Emptying the bladder in a sitting position Loosening the abdominal muscles during voiding Massaging downwards over the lower abdomen and bladder

-Loosening the abdominal muscles during voiding The abdominal muscles should be tightened for complete voiding of the urine and to prevent urine stasis. Difficulty in voiding the urine in patients with diabetes is due to autonomic neuropathy. Emptying the bladder every three hours helps to prevent stasis and subsequent infections. Emptying the bladder in a sitting position helps to void the urine completely. Massaging downwards over the lower abdomen and bladder may promote complete bladder emptying. p. 1150

The nurse expects that which medication will be included in the drug therapy for a patient that has a thyroxine level of 14 µg/dL? Natamycin Mirtazapine Methimazole Acetaminophen

-Methimazole A thyroxine level of 14 µg/dL indicates hyperthyroidism. Methimazole is used to treat hyperthyroidism and is an antithyroid drug. Natamycin is used to treat ophthalmic conditions. Mirtazapine is prescribed to patients diagnosed with depression. Acetaminophen is an antipyretic and pain reliever. p. 1165

A patient with hypertension reports a severe pounding headache and profuse sweating. Upon assessment, the patient is found to have tachycardia. What drug should be prescribed by the primary health care provider? Metyrosine Ketoconazole Spironolactone Dexamethasone

-Metyrosine Severe pounding headache, profuse sweating, and tachycardia are manifestations of pheochromocytoma; metyrosine can manage these symptoms. Ketoconazole is prescribed to suppress the synthesis and secretion of cortisol from the adrenal gland. Spironolactone is used to treat hyperaldosteronism. Dexamethasone is prescribed for the treatment of adrenal hyperplasia. p. 1182

The nursing care of a patient who had a parathyroidectomy should include which actions? Monitor intake and output Monitor for Babinski's sign Ensure that intravenous (IV) calcium is available Instruct patient to maintain bed rest for 48 hours Assess for numbness and tingling of the hands and mouth

-Monitor I/O -Ensure IV Ca is available -Assess for numbness and tingling of hands and mouth Intake and output are assessed carefully because of the patient's risk for fluid imbalance. IV calcium gluconate or gluceptate should be readily available for administration because the postoperative parathyroidectomy patient is at risk for hypocalcemia, which can lead to life-threatening tetany. Numbness and tingling of the hands and mouth are signs of mild tetany. Babinski's sign is not assessed in postoperative parathyroidectomy patients. Chvostek's and Trousseau's signs are assessed to monitor for signs of tetany. Mobility should be encouraged to promote bone calcification. pp. 1172-1173

The health care provider was unable to spare a patient's parathyroid gland during a thyroidectomy. Which assessments should the nurse prioritize when providing postoperative care for this patient? Assessing the patient's white blood cell levels and assessing for infection Monitoring the patient's hemoglobin, hematocrit, and red blood cell levels Monitoring the patient's serum calcium levels and assessing for signs of hypocalcemia Monitoring the patient's level of consciousness and assessing for acute delirium or agitation

-Monitoring the patient's serum calcium levels and assessing for signs of hypocalcemia Loss of the parathyroid gland is associated with hypocalcemia. Infection and anemia are not associated with loss of the parathyroid gland, whereas cognitive changes are less pronounced than the signs and symptoms of hypocalcemia. p. 1173

Which population experiences the most disparity related to the amount of complications from diabetes? White Americans Native Americans African Americans Hispanic Americans

-Native Americans Native Americans have a six times higher rate of end-stage renal disease and a four times higher rate of amputation than other ethnicities with diabetes, including white Americans, African Americans, and Hispanic Americans. p. 1137

A patient with diabetes mellitus needs a mitral valve replacement. What is the most important preoperative teaching the nurse should provide to prevent a cardiac infection postoperatively? Avoid sick people and wash hands Obtain comprehensive dental care Maintain hemoglobin A1C below 7 percent Coughing and deep breathing with splinting

-Obtain comprehensive dental care A person with diabetes is at high risk for postoperative infections. The most important preoperative teaching to prevent a postoperative infection in the heart is to have the patient obtain comprehensive dental care because the risk of septicemia and infective endocarditis increases with poor dental health. Avoiding sick people, hand washing, maintaining hemoglobin A1c below 7%, and coughing and deep breathing with splinting would be important for any type of surgery, but are not the priority with mitral valve replacement for this patient. p. 1140

The nurse is caring for a patient with newly diagnosed type 2 diabetes mellitus. Which symptoms indicate that the patient is experiencing hyperglycemia? -Polydipsia, polyuria, and polyphagia -Weight gain, fatigue, and bradycardia -Irritability, diaphoresis, and tachycardia -Loss of appetite, abdominal pain, and oliguria

-Polydipsia, polyuria, and polyphagia Symptoms of hyperglycemia, as seen in both forms of diabetes mellitus, include polydipsia, polyuria, polyphagia, and weight loss. Patients with hyperglycemia due to diabetes mellitus do not manifest weight gain, loss of appetite or oliguria, or bradycardia, but they may exhibit fatigue, tachycardia, and abdominal pain. Irritability and diaphoresis are manifestations of hypoglycemia (low blood sugar). p. 1124

A nurse is caring for a 24-year-old woman with no available medical history. The patient states that she has been vomiting for two days and feels weak. She states that she cannot seem to drink enough water at home and urinates more than usual throughout the day. The laboratory results reveal an arterial blood pH of 7.28, sodium level of 155 mEq/L, potassium level of 3.5 mEq/L, serum glucose level of 550 mg/dL, sodium bicarbonate level of 10 mEq/L, and a high level of ketones in the urine. What will the nurse include in this patient's plan of care? Potassium replacement Assessment of mental status Administration of long-acting insulin Assessment of blood glucose levels Administration of intravenous (IV) fluids

-Potassium replacement -Assessment of mental status -Assessment of blood glucose levels -Administration of intravenous (IV) fluids The patient is experiencing diabetic ketoacidosis (DKA), which is defined by a serum glucose level over 250 mg/dL, an arterial blood pH lower than 7.30, a serum bicarbonate level less than 16 mEq/L, and a moderate to high level of ketones in the urine or serum. Treatment for a patient with DKA includes electrolyte replacement (in this case potassium), administration of IV fluids for dehydration, assessment of mental status, and assessment of blood glucose levels. The treatment for DKA is administration of short-acting insulin, not long-acting insulin. pp. 1143-1144

A patient suffering from pheochromocytoma is scheduled for surgery. Before the procedure, the patient develops dysrhythmias. What is the appropriate treatment for this patient? -Atenolol -Metyrosine -Propranolol -Phenoxybenzamine

-Propranolol Propranolol is an adrenergic receptor blocker used to treat dysrhythmias in a patient with pheochromocytoma. Atenolol is used to treat hypertension. Metyrosine is used to decrease catecholamine production when surgery is not an option. Phenoxybenzamine is used to reduce blood pressure and symptoms of excess catecholamines. pp. 1181-1182, 1215

The patient with an adrenal hyperplasia is returning from surgery for an adrenalectomy. For what immediate postoperative risk should the nurse plan to monitor the patient? Vomiting Infection Thromboembolism Rapid blood pressure changes

-Rapid BP change The risk of hemorrhage is increased with surgery on the adrenal glands as well as large amounts of hormones being released in the circulation, which may produce hypertension and fluid and electrolyte imbalances for the first 24 to 48 hours after surgery. Vomiting, infection, and thromboembolism may occur postoperatively with any surgery. pp. 1176-1177

The nurse is educating a diabetic patient about the use of premixed insulin neutral protamine hagedorn /regular 70/30. What should the nurse inform the patient about using this insulin? Shake the bottle thoroughly to mix the insulin. Rotate the injection within one anatomic site for a week. Inject insulin at a 15- to 30-degree angle. Inform that the fastest subcutaneous absorption is from the thigh.

-Rotate the injection within one anatomic site for a week. The nurse should teach the patient to rotate the injection within one anatomic site, such as the abdomen, for at least one week before using a different site to allow for better absorption of insulin. It is important to gently roll the insulin bottle between the palms 10 to 20 times to warm the insulin and resuspend the particles. Injections must be administered at a 45- to 90-degree angle, depending on the thickness of the patient's fat pad. The fastest subcutaneous absorption is from the abdomen, followed by the arm, thigh, and buttock. pp. 1127-1128

The nurse is providing discharge instructions to a patient who has a neurogenic bladder. Which self-care activities would the patient identify to facilitate bladder emptying to help prevent urinary stasis and infection? Sitting to void Using the Credé maneuver when voiding Emptying the bladder at least three times a day Tightening the abdominal muscles when voiding Maintaining a fluid restriction of 1200 mL per day

-Sitting to void -Using the Credé maneuver when voiding -Tightening the abdominal muscles when voiding Sitting to void, the Credé maneuver, and tightening the abdominal muscles when voiding all aid in fully emptying the bladder, which will help to prevent urinary stasis and infection. The patient should also empty the bladder every three hours. Fluid restriction will not aid in emptying the bladder. p. 1150

A female patient who is on drug therapy for hyperaldosteronism develops menstrual disorders. Which prescribed drug may be the cause of this condition? -Spironolactone -Amlodipine -Dexamethasone -Aminoglutethimide

-Spironolactone Spironolactone is a potassium-sparing diuretic given to patients with hyperaldosteronism to treat hyperkalemia. This drug can cause menstrual disorders in women. Amlodipine and dexamethasone both control high blood pressure. Aminoglutethimide is given to decrease aldosterone synthesis. pp. 1180-1181

A patient reports "eye problems". On assessment of this patient, the nurse notes exophthalmos. What other abnormal assessments should the nurse expect to find in this patient? Puffy face, decreased sweating, and dry hair Muscle aches and pains and slow movements Decreased appetite and increased thirst and pallor Systolic hypertension and increased heart rate

-Systolic HTN and increased heart rate The patient's symptoms point to Graves' disease, or hyperthyroidism; its symptoms would also include systolic hypertension, increased heart rate, and increased thirst. Puffy face, decreased sweating, dry, coarse hair, muscle aches and pains, slow movements, decreased appetite, and pallor are all manifestations of hypothyroidism. pp. 1163-1164

The nurse creates a plan of care for a patient with Graves' disease. What is an appropriate expected outcome? The patient will be free of infection. The patient will remain awake, alert, and oriented. The patient will be compliant with fluid restrictions. The patient will demonstrate maintenance of his weight.

-The patient will demonstrate maintenance of his weight. Graves' disease, which results from hyperthyroidism, causes an increase in metabolism. Untreated, it may cause unexplained weight loss. It is important for the nurse to plan care to support an expected outcome to maintain or gain weight. Risk for infection and fluid overload are not direct issues related to hyperthyroidism. Because of the increased secretion of thyroid hormone, these patients will be hyperalert and anxious and may have difficulty sleeping. Therefore, the goal of remaining awake, alert, and oriented is not a priority. pp. 1165-1166

After administering an intramuscular (IM) glucagon injection in an unconscious patient, why does the nurse turn the patient on the side? To prevent aspiration To avoid postural hypotension To promote the patient's comfort To help the patient regain consciousness

-To prevent aspiration IM glucagon is administered for hypoglycemia. Because nausea is a common reaction after glucagon injection, the patient should be turned to one side until gaining consciousness in order to prevent aspiration if vomiting occurs. Because the patient is unconscious, turning to the side will not promote the patient's comfort. The patient who is unconscious due to severe hypoglycemia will regain consciousness due to administration of the glucagon injection. pp. 1146-1147

What does the nurse include in the teaching plan for the client who is receiving radioactive iodine? Private bathroom facilities are not necessary unless the patient is incontinent. Radioactive iodine therapy is contraindicated in women of childbearing age. Towels that are used by the patient should not be used by other family members. The patient should avoid being around pregnant women and children for 48 hours after treatment.

-Towels that are used by the patient should not be used by other family members. To decrease risk of radiation exposure to household contacts, towels and bed linens used by the patient should not be handled by other members of the household and should be washed daily, separate from other household laundry. The patient who has been treated with radioactive iodine should use separate bathroom facilities and should flush two to three times after each use. Radioactive iodine may not be given to a pregnant woman. A pregnancy test must be administered to women of childbearing age to rule out pregnancy, before initiation of therapy. The patient who has received radioactive iodine should avoid close proximity to pregnant woman or children for seven days following treatment. p. 1166

When discussing long-term management of Addison's disease with a patient, the nurse includes which self-care management measures? -The patient will need to follow a low-sodium diet. -When taking antacids, the patient may need to decrease corticosteroid medication. -The patient must notify the health care provider whenever experiencing vomiting or diarrhea. -The patient will need to take extra medication when experiencing either physical or emotional stress. -The patient or patient's caregiver will need to administer corticosteroids subcutaneously in the case of an emergency, and the patient cannot take hormone replacements orally.

-When taking antacids, the patient may need to decrease corticosteroid medication. -The patient must notify the health care provider whenever experiencing vomiting or diarrhea. -The patient will need to take extra medication when experiencing either physical or emotional stress. Vomiting and diarrhea can deplete cortisol levels and parenteral replacement may be needed. The patient with Addison's disease is unable to tolerate physical or emotional stress without exogenous corticosteroids and may need to increase medication at these times. Patients with Addison's disease will need to increase their sodium intake, because they are at risk for hyponatremia. Antacid intake will necessitate increased corticosteroid hormone therapy. Corticosteroids must be given intramuscularly when the patient is unable to take them orally. pp. 1178-1179

What complications may arise if pheochromocytoma is left untreated? Diabetes mellitus Graves' disease Alzheimer's disease Chronic kidney disease

Diabetes mellitus may occur if pheochromocytoma is left untreated. Graves' disease, Alzheimer's disease, and chronic kidney disease are not complications of pheochromocytoma. p. 1181

The nurse is caring for a patient diagnosed with diabetes mellitus (DM) who has developed insulin resistance. Which class of glucose-lowering agents can reduce insulin resistance? DPP-IV inhibitors Dopamine agonists Thiazolidinediones α-glucosidase inhibitors

Thiazolidinediones Thiazolidinediones are often referred to as "insulin sensitizers." These agents improve insulin sensitivity, transport, and utilization at target tissues. Because they do not increase insulin production, thiazolidinediones do not cause hypoglycemia when used alone. Examples of thiazolidinediones include rosiglitazone and pioglitazone. DPP-IV inhibitors inactivate the hormone incretin. Dopamine agonists activate dopamine receptors and α-glucosidase inhibitors delay carbohydrate absorption in the small intestine. pp. 1130, 1131

A patient being treated conservatively for hyperparathyroidism is being given discharge instructions. What statement made by the patient informs the nurse that the discharge instructions have been understood? "I should exercise regularly." "I should avoid excess dietary fiber." "I should restrict my fluids to 1000 mL daily." "I should report tingling in my hands and around my mouth."

"I should exercise regularly." Hyperparathyroidism is a condition of increased parathyroid hormone (PTH) secretion. PTH regulates serum calcium levels by stimulating bone resorption. When PTH levels are elevated, calcium resorption is accelerated. This loss of calcium from the bones causes hypercalcemia and puts the bones at risk for pathologic fractures. Patients with hyperparathyroidism can decrease bone loss through regular weight-bearing exercises. While high impact exercises put the patient at risk for pathologic fracture, walking is an important means of decreasing the rate of bone resorption. Hypercalcemia leads to constipation. The patient with hyperparathyroidism benefits from a high-fiber diet. Hypercalcemia predisposes the patient to renal stones; adequate fluid intake decreases the risk of renal stones. Tingling in the hands and around the mouth is associated with tetany, a condition resulting from a sudden drop in serum calcium. Tetany is associated with hypocalcemia; it may occur postoperatively following parathyroidectomy. It is not associated with the state of hypercalcemia that is seen normally with untreated or undertreated hyperparathyroidism. p. 1173

The nurse is educating the patient regarding administration of meal-time insulin, aspart. Which statement by the patient indicates correct knowledge of the onset of action of this medication? "I will administer my aspart 30 minutes before mealtime." "I will administer my aspart 60 minutes before mealtime." "I will administer my aspart within 15 minutes of eating my meal." "I will administer my aspart 30 minutes after the conclusion of my meal."

"I will administer my aspart within 15 minutes of eating my meal." Aspart is rapid-acting insulin, onsets within five minutes, and peaks within an hour. The patient is instructed to administer it when food is in front of him or her, making the option "I will administer aspart within 15 minutes of eating" correct. If the patient administers the aspart 30 or 60 minutes before the food arriving, the patient may experience hypoglycemia. The patient may have hyperglycemia if he or she waits 30 minutes until after eating to administer the insulin. p. 1126

Which statement of the patient with diabetes indicates ineffective learning about management of hypoglycemia? "I will not eat large quantities of quick-acting carbohydrates." "I will recheck my glucose level 30 minutes after eating 15 g of carbohydrate." "I will not contact the primary health care provider if my symptoms subside after two doses of carbohydrate." "I will not eat candy bars and ice cream, because they have a lot of sugar and fat in them, which is not good for my health."

"I will recheck my glucose level 30 minutes after eating 15 g of carbohydrate." The blood glucose level is less than 70 mg/dL in hypoglycemia. This is treated by ingesting 15 g of simple carbohydrate and rechecking the glucose levels 15 minutes later. If the levels are still below 70 mg/dL, the treatment is repeated two to three times. Overtreatment with large quantities of quick-acting carbohydrates should be avoided to prevent rapid fluctuation to hyperglycemia. If improvement is not observed, the primary health care provider should be contacted. Fats are present in candy bars and ice cream, which may slow down the absorption of glucose and delay the response to treatment. pp. 1146-1147

Which patient statement indicates the need for further education regarding the management of both cardiac disease and hypothyroidism? "I will use an enema for constipation." "I will use a sedative to treat insomnia." "I should take my thyroid medication in the morning before eating." "I should not switch to another brand of hormone unless I check with my health care provider."

"I will use an enema for constipation." Enemas are contraindicated for patients diagnosed with both cardiac disease and hypothyroidism. Enemas cause vagal stimulation that can lead to fainting. The patient is taught to use laxatives, stool softeners, and to consume a fiber-rich diet to treat constipation, rather than using enemas. Using low-dose sedatives is recommended if the patient is experiencing insomnia. Thyroid medication should be taken in the morning before food. Switching to different brands is not recommended, because bioavailability may differ with different brands. pp. 1169, 1170

A patient with pheochromocytoma is prescribed propranolol during preoperative care. Which instruction provided by the nurse is most appropriate to prevent complications in the patient? "Obtain adequate rest." "Make postural changes cautiously." "Have a blood pressure check frequently." "Consult your primary health care provider if you have severe headache."

"Make postural changes cautiously." Propranolol is a β-adrenergic receptor blocker that is administered during preoperative care to treat tachycardia, dysrhythmias, and high blood pressure, in order to prevent intraoperative hypertensive crisis. Propranolol causes orthostatic hypotension, so postural changes should be made cautiously, to prevent falls. Adequate rest should be taken by the patient, but it is not related to preventing falls. Blood pressure should be monitored regularly to prevent hypertensive crisis. A severe headache should be reported to the primary health care provider for immediate intervention; however, this condition is unconnected to complications of propranolol. p. 1181

A nurse teaches a student nurse about pancreas transplantation. While caring for a patient whose pancreas has been transplanted, which instruction given by the student nurse strongly suggests ineffective learning? "Exogenous insulin is not required." "Dietary restrictions are not required." "Immunosuppression is required for life." "Regular monitoring of glucose level is required."

"Regular monitoring of glucose level is required." After pancreatic transplantation, homeostasis of glucose level is achieved. There is no need for regular monitoring of the glucose level. Pancreatic transplantation helps in maintaining a normal glucose level, so exogenous insulin is not required. Many dietary restrictions can be lifted. Lifetime immunosuppression is very important to avoid organ rejection, which may happen after pancreatic transplantation. p. 1137

A patient prescribed metformin complains of an "upset stomach" after ingestion of the medication. The nurse asks a student nurse what suggestion he or she would make. What is the most appropriate suggestion by the student? "Stop taking the medication immediately and notify the prescriber." "Take metformin with food to decrease gastrointestinal (GI) side effects." "Get your blood glucose checked, because it sounds like hypoglycemia." "Take diphenhydramine 25 mg before taking metformin to prevent nausea."

"Take metformin with food to decrease gastrointestinal (GI) side effects." The student nurse should suggest that the patient take metformin with food to decrease GI side effects. It is not within the nurse's scope of practice to prescribe medications such as diphenhydramine for nausea. Advising the patient to stop the medication immediately may result in a hyperglycemic response and should not be done without medication prescriber guidance. Getting the patient's blood glucose checked will not address the complaints of GI distress. p. 1130

A patient with adrenal insufficiency is advised to take corticosteroids for four months. What should be told to the patient about how to prevent osteoporosis? . "Eat a protein-rich diet." "Take vitamin D tablets." "Avoid a calcium-rich diet." "Avoid bisphosphonates." "Avoid high-impact exercise."

"Take vitamin D tablets." "Avoid high-impact exercise." Vitamin D tablets should be taken to aid in calcium absorption to prevent osteoporosis. The patient should be advised to do low-impact exercise rather than high-impact exercise, because high-impact exercise may lead to complications. A protein-rich diet should be eaten by patients undergoing corticosteroid therapy; this diet will not lower the risk of osteoporosis. A calcium-rich diet and bisphosphonates help to prevent osteoporosis. p. 1180

A patient with type 2 diabetes who takes metformin daily to manage blood sugar is scheduled for an intravenous pyelogram (IVP). Which question by the nurse is most important to ask the patient when preparing for the procedure? "Have you ever skipped a dose of metformin?" "When was the last time you took your metformin?" "How many times a day do you take your metformin?" "How long have you been taking metformin for diabetes?

"When was the last time you took your metformin?" During an IVP, contrast dye is injected so that the urinary system can be visualized. To reduce risk of kidney injury, metformin should be discontinued a day or two before the procedure and for 48 hours following the procedure. Medication administration adherence, dosage, and history are important to assess, but will not affect the interaction. p. 1130

Which test is more reliable to diagnose pheochromocytoma? Urinary cortisol Urine osmolality Urinary creatinine Urinary aldosterone

-Urinary creatinine Pheochromocytoma is a disorder of the adrenal medulla; urinary creatinine is used to diagnose this disorder. Urinary cortisol, urine osmolality, and urinary aldosterone are used to diagnose Addison's disease. p. 1181

The nurse is teaching the caregiver about the manifestations of hypoglycemia in the diabetic patient. What should the caregiver identify as a manifestation of hypoglycemia? Increase in urination Abdominal cramps Nervousness and tremors Nausea and vomiting

Nervousness and tremors; cold, clammy skin; and numbness of the fingers and toes are some of the manifestations of hypoglycemia which the caregiver should watch for out in the patient. An increase in urination, abdominal cramps, and nausea and vomiting are manifestations of hyperglycemia. Test-Taking Tip: Do not worry if you select the same-numbered answer repeatedly, because there usually is no pattern to the answers. p. 1143